Health Bill Changes Everything

March 29th, 2010

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This piece was originally posted in the National Journal.

“I can’t guarantee that this is good politics,” President Obama told House Democrats the day before Sunday’s climactic health care vote. Is it?

Democratic pollsters Patrick Caddell and Douglas Schoen warned party members that if they passed the bill in defiance of public opinion, they would “run the risk of unmitigated disaster in November.” Sen. Lamar Alexander, R-Tenn., called enactment “a historic mistake.”

Massachusetts voters shouted “Stop” when they elected Republican Scott Brown to the Senate in January. “One thing is clear,” Brown said on Election Night. “Voters do not want the trillion-dollar health care bill that is being forced on the American people.” Sen. John Cornyn, R-Texas, who heads the National Republican Senatorial Committee this year, told reporters, “This will make sure that health care is the No. 1 issue that the election is won or lost on in November.

The prediction of electoral catastrophe for Democrats may turn out to the most overwrought forecast since Y2K. The reason is this: Once the health care legislation is law, everything changes.

Conservative activists, led by the Club for Growth, are trying to get Republican candidates to sign a pledge to vote to repeal health care reform. Repeal won’t happen as long as Obama is president, because he would veto such legislation. But conservatives may see repeal as an issue they can use to win control of Congress.

If Republicans do run on repeal, however, two things will happen. First, they will rally the Democratic Party’s base. Ever since the health care debate started last June, opponents of reform have felt more intensely about the issue than have supporters. Nearly every poll showed more strong opposition than strong support, often by ratios of 2-to-1. That could change if Republicans threaten to undo the measure.

Obama told House Democrats before the vote that once he signs health care reform legislation, “it’s going to be a little harder [for opponents] to mischaracterize what this effort has been all about.” Some of the most popular insurance reforms will take effect this year. Insurance companies will no longer be able to exclude children with pre-existing conditions, or drop coverage if people get sick, or impose lifetime limits on coverage. Those Americans who have health insurance and are satisfied with it — and that’s the overwhelming majority — will discover that nothing much has changed. They can keep their health insurance and their doctor.

They will also discover that they have new rights and benefits. It’s always risky to threaten to take away anybody’s rights and benefits. Democrats, even those who were originally skeptical, will rally to the cause of defending them.

Second, voters are unlikely to want to return to the status quo ante reform. Yes, the public had a lot of qualms about the Democratic bill. But one thing was perfectly clear from all the polls taken over the past year: People were dissatisfied with the status quo. They wanted change. Maybe not this particular bill, but they wanted change.

In a poll taken this month by the Pew Research Center for the People and the Press, the public generally opposed the health care legislation under discussion in Congress, 48 percent to 38 percent. Among those opposed, a solid majority said they wanted Congress to begin working on new health care legislation. Only 18 percent of the public wanted to keep the status quo.

An NBC News/Wall Street Journal poll in mid-March found much the same thing. By 48 percent to 36 percent, respondents opposed Obama’s health care plan. What if the plan lost in Congress? An overwhelming 85 percent said they would want Congress to consider significant health care reform again, either immediately (47 percent) or in the next few years (38 percent). Only 13 percent favored keeping the status quo.

In the Pew poll, 51 percent of Americans said that if the Obama plan passed, their health care costs would go up. But 63 percent said that their costs would go up if no changes were made to the health care system. The reform bill was never popular. But the status quo was even less popular.

Now everything changes. This, more than anything else: Obama has won a historic victory. He looks like a winner. And in American politics, winning begets winning.